Student Extern

Enter your Social Security Number in the space indicated. Your Social Security Number is requested under the authority of Executive Order 9397 to uniquely identify your records from those of other applicants who may have the same name. As allowed by law or Presidential directive, your Social Security Number is used to seek information about you from employers, schools, banks and others who may know you. Providing your Social Security Number is voluntary, however we can not process your application without it.

Vacancy Identification Number

Vacancy Identification Number: 833645

Announcement Number: IHS-13-HQ-833645-ESEP/MP

1. Title of Job

Student Extern2. Biographic Data

3. E-Mail Address

4. Work Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

5. Employment Availability

6. Citizenship

Are you a citizen of the United States?7. Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

8. Other Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

9. Languages

If you are applying by the OPM Form 1203-FX, leave this section blank.

10. Lowest Grade

Enter the lowest grade level that you will accept for this position. The lowest grade for this position is 03.

0304050709

11. Miscellaneous Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

12. Special Knowledge

If you are applying by the OPM Form 1203-FX, leave this section blank.

13. Test Location

If you are applying by the OPM Form 1203-FX, leave this section blank.

14. Veteran Preference Claim

15. Dates of Active Duty - Military Service

16. Availability Date

17. Service Computation Date

If you are applying by the OPM Form 1203-FX, leave this section blank.

18. Other Date Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

19. Job Preference

You may select up to 3 area locations:1 Aberdeen Area (Serves North Dakota, South Dakota, Iowa, and Nebraska)2 Alaska Area (Serves the Stae of Alaska)3 Alburquerque Area (Serves New Mexico, Colorado, and Texas)4 Bemidji Area (Serves Indiana, Minnesota, Michigan, and Wisconsin)5 Billings Area (Serves Montana and Wyoming)6 California Area (Serves California and Hawaii)7 Nashville Area (Serves Eastern United States)8 Navajo Area (Serves Northern Arizona, New Mexico, and Utah)9 Oklahoma Area (Serves Oklahoma, Kansas, and Texas)10 Phoenix Area (Serves Arizona, California, Nevada, and Utah)11 Portland Area (Serves Idaho, Oregon, and Washington)12 Tucson Area (Serves Southern Arizona)

List your location preference including city and state. If clinic or hospital known, provide city and state and name of facility in the space below:20. Occupational Specialties

Select/enter at least one occupational specialty. The specialty code for this position is001 Student Extern

21. Geographic Availability

Select/enter at least one geographic location in which you are interested and will accept employment. The location code for this position is:

990000000 Location Negotiable After Selection

22. Transition Assistance Plan

23. Job Related Experience

If you are applying by the OPM Form 1203-FX, leave this section blank.

24. Personal Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

25. Occupational/Assessment Questions:

Thank you for your interest in this Student Extern position with the Indian Health Service.We will evaluate your resume and your responses to this Assessment Questionnaire to determine if you are among the best qualified for this position. Your responses are subject to verification. Please review your responses for accuracy before you submit this questionnaire.SECTION I. MINIMUM QUALIFICATIONS AND FACTORS.

1. Are you a United States Citizen or National, who is at least 16 years old?

A. YesB. No

2. From the following list, select the response that best describes your status. (Please select only one answer)

Salary is based on experience and the number of completed semester hours in your academic program according to Personnel Standards, rules and regulations. The ratings listed below are proposed grade levels based on the number of credit hours completed. The human resources office responsible for the extern position will determine your grade level. Transcripts must be provided during the online application process.

The following questions allow us to determine your grade placement within the Indian Health Service Extern program.

3. GS-3 From the list below select the appropriate response that applies to the level of education you've attained.

A. I have completed 30 semester hours/45 quarter hoursB. I do not meet any of the requirements as described above.

4. GS-4 From the list below select the appropriate response that applies to the level of education you've attained.

A. I have completed 60 semester hours/90 quarter hours.B. I do not meet any of the requirements as described above.

5. GS-5 From the list below select the appropriate response that applies to the level of education you've attained.

A. I have completed bachelor's degree (120 semester hours/180 quarter hours).B. I do not meet any of the requirements as described above.

6. GS-7 From the list below select the appropriate response that applies to the level of education you've attained.

A. I have completed first year of graduate school (18 semester hours of graduate education, 27 quarter hours of graduate selection).B. I do not meet any of the requirements as described above.

7. GS-9 Master's or equivalent graduate degree or 2 full years of progressively higher graduate education leading to such a degree or LL.B or J.D., if related

A. I have completed education as described above.B. I do not meet any of the requirements as described above.

The following questions allow us to determine your program eligibility and will be verified with the transcript you submit with your application.

8. From the list below identify your current Grade Point Average (GPA)

A. My GPA is lower than 2.0B. My GPA is between 2 and 2.44C. My GPA is between 2.45 and 2.94D. My GPA is 2.95 or higherE. I have not yet enrolled and do not have a GPA

9. From the following list, select the academic health or allied health profession program or career track you are enrolled in. (Please select only one answer).

From the following list, select the areas in which you have experience in a health or medical facility. (Please select Yes or No)

A- YesB- No

10. Assist in the day-to-day operations of the administrative office.

11. Assist any health professional in a specified section in clinical services.

12. Assist any health professional in Community Health Services.

13. Assist Nursing staff.

14. This position requires you to work with medical patients in a health center. Have you handled confidential materials or matters?

A. YesB. No

15. Choose the statement from the list below that best describes your self-assessment of the level of job knowledge you perform when gaining hands-on instructive experience.

A. I do not have experience in a hands-on instructive environment.B. I have some experience in a hands-on instructive environment.C. I have knowledge but I do not apply it in some situations. I require regular supervision in day-to-day work.D. I have good working knowledge of the rules and procedures. I only need occasional supervision with new duties or complicated assignments.E. I display knowledge and application of skills; I strive to learn more about business. I set own goals and I am organized in my approach.

16. Choose the statement from the list below that best describes your self-assessment of the level of self-development you perform when gaining hands-on instructive experience.

A. I do not have experience in a hands-on instructive environment.B. I accept constructively offered feedback but I do not seek it out.C. I occasionally accept learning opportunities offered by others.D. I respond positively to feedback when offered. I accept learning opportunities provided and seek them out on my own. I prepare and implement my own development plan.E. I present a professional image and seek feedback to modify own behavior. I regularly seek learning opportunities. I proactively prepare and implement a development plan.

17. Choose the statement from the list below that best describes your self-assessment of the level of initiative you perform when gaining hands-on instructive experience.

A. I do not have experience in a hands-on instructive environment.B. I do not seek new assignments; I reluctantly accept assignments or changes to work process.C. I follow verbal or written instructions to complete an assignment .D. I accept new assignments and I welcome the opportunity for growth.E. I seek new assignments and opportunities to learn, I accept new tasks and follows through until completed. I volunteer to help.

18. Choose the statement from the list below that best describes your self-assessment of the level of communication you perform when gaining hands-on instructive experience.

A. I do not have experience in a hands-on instructive environment.B. I must be prompted to share information and to interact with team, department and customers.C. I display basic interpersonal and communication skills with others to achieve goals.D. I communicate information that can be helpful to others. I update co-workers on progress. I share information willingly. I collaborate on solutions.E. I research solutions to issues and provide information to my peers.

From the following list, identify those customer service functions that you have provided in a health care environment. (Please select Yes or No)

24. Choose the statement from the list below that best describes your self-assessment of the level of teamwork you perform when gaining hands-on instructive experience.

A. I do not have experience in a team environment.B. I work within own team, I am occasionally reluctant to work with others. I need frequent supervision when issues arise with coworkers/others.C. I am agreeable; I work well with co-workers to achieve departmental goals.D. I work on maintaining relationships with coworkers, supervisor and other departments. I am willing to help where needed.E. I have participated in a group to complete a project.

25. Choose the statement from the list below that best describes your self-assessment of the level of problem solving you perform when gaining hands-on instructive experience.

A. I do not have experience in a hands-on instructive environment.B. I have difficulty solving routine problems; I tend to make decisions without obtaining all necessary information or considering implications.C. I have had training in problem solving but have not applied it on the job.D. I make good decisions on routine issues by considering options and consequences. I may require assistance on more complex issuesE. I make effective decisions by applying logic, research and using sound judgment. I only need occasional guidance.

SECTION II. CERTIFICATION OF INFORMATION ACCURACY

As previously explained, your responses in this Assessment Questionnaire are subject to evaluation and verification. Later steps in the selection process are specifically designed to verify your responses. Deliberate attempts to falsify information will be grounds for disqualifying you or for dismissing you from employment following acceptance. Please take this opportunity to review your responses to ensure their accuracy.

Certification of Information Accuracy If you fail to answer this question, you will be disqualified from consideration for this position.

26. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled, I may be denied an appointment, or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated. I understand that responding "No" to this item will result in my not being considered for this position.

A. Yes, I certify that the information provided in this questionnaire is true, correct and provided in good faith, and I understand the information provided above.B. No, I do not certify/understand the information provided above.